• Mathilde Gottschau, Susanne Rosthøj, Annette Settnes, Gitte Lerche Aalborg, Jakob Hansen Viuff, Christian Munk, Allan Jensen, Susanne K Kjær, and Lene Mellemkjær.
• Diet, Cancer and Health, Danish Cancer Society Research Center, Copenhagen, Denmark (M.G., J.H.V., L.M.).
• Ann. Intern. Med. 2023 May 1; 176 (5): 596604596-604.

BackgroundMore evidence is needed to substantiate current recommendations about removing ovaries during hysterectomy for benign conditions.ObjectiveTo compare long-term outcomes in women with and without bilateral salpingo-oophorectomy (BSO) during hysterectomy for benign conditions.DesignEmulated target trial using data from a population-based cohort.SettingWomen in Denmark aged 20 years or older during 1977 to 2017.Participants142 985 women with hysterectomy for a benign condition, 22 974 with BSO and 120 011 without.InterventionBenign hysterectomy with or without BSO.MeasurementsThe primary outcomes were overall hospitalization for cardiovascular disease (CVD), overall cancer incidence, and all-cause mortality through December 2018.ResultsCompared with women without BSO, women with BSO who were younger than 45 years at surgery had a higher 10-year cumulative risk for hospitalization for CVD (risk difference [RD], 1.19 percentage points [95% CI, 0.09 to 2.43 percentage points]). Women with BSO had a higher 10-year cumulative risk for cancer for ages 45 to 54 years (RD, 0.73 percentage point [CI, 0.05 to 1.38 percentage points]), 55 to 64 years (RD, 1.92 percentage points [CI, 0.69 to 3.25 percentage points]), and 65 years or older (RD, 2.54 percentage points [CI, 0.91 to 4.25 percentage points]). Women with BSO had higher 10-year mortality in all age groups, although the differences were statistically significant only for ages 45 to 54 years (RD, 0.79 percentage point [CI, 0.27 to 1.30 percentage points]). The mortality at 20 years was inconsistent with that at 10 years in women aged 65 years or older.LimitationAge was a proxy for menopausal status.ConclusionThe authors find that these results support current recommendations for conserving ovaries in premenopausal women without a high risk for ovarian cancer and suggest a cautious approach in postmenopausal women.Primary Funding SourceThe Danish Cancer Society's Scientific Committee and the Mermaid Project.

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